Adverse Outcomes in Neonates Following Planned Home Births: A Case Report Series and a Narrative Literature Review

Abstract

Background: Although home births provide personal and intimate experiences, they pose potential risks that may be better managed in hospital settings. The safety of home birth remains highly debated, with no consensus on its safety or potential adverse events, and its adoption varies widely across the world. In Italy, the Italian Society of Neonatology opposed this practice, resulting in one of the lowest home birth rates in Europe (approximately 0.1% of total births). This study evaluated the impact of planned home births on neonatal health, with a focus on severe complications requiring intervention in the pediatric emergency department (PED). Methods: Cases were collected from patients admitted to IRCCS Istituto Giannina Gaslini Children's Hospital between January 2022 and December 2024. The analysis focused on neonates born at home, who required emergency care for life-threatening conditions. Results: We identified five cases, with an incidence of approximately 0.65 per 10,000 PED visits and a complication rate of 15-30% for all planned home births. Factors contributing to unfavorable outcomes include lack of advanced medical equipment, timely diagnostics, and comprehensive postpartum screening. Thus, while proponents argue that home births can provide a more comfortable and personalized experience, concerns about safety and associated risks persist. Conclusions: This study aims to highlight the necessity of adopting hospital-level neonatal care protocols for home births, particularly during the critical first 48 h of life, to mitigate risks and ensure optimal neonatal outcomes.

Keywords: early-onset neonatal sepsis; home births; hypoglycemia; kernicterus; morbility; pediatric emergency department.